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47 Cards in this Set
- Front
- Back
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Epidemiology of BC
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Affects 1/10 women UK: risk 1/50 by 50, 1/17 by 65, 1/9 by 85
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Male BC incidence
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1/300
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If 1st degree relative
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Double risk
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Increased risk if FHx
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Relative <50yrs, bilat any age
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Commonest genes
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BRCA 1 & 2
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BRCA2 location
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Long arm chromosome 13
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BRCA1 location
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Long arm chromosome 17
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BRCA1 features
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2% Ashkenazi Jews, commoner in FHx breast & ovarian ca
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Either gene risk increase
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40-80% lifetime risk
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Menstruation & BC risk
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Greater no., delay until pregnancy = greater risk
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OCP & BC risk
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>4yrs in young females prior to preg increases risk premenopausal BC, short use OCP between preg no increased risk
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HRT & BC risk
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'Million Women Study' = oestrogen only HRT small increase risk, oestrogen-progesterone HRT double double risk and increases
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Benign breast disease & BC risk
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Most not RF, atypical epithelial hyperplasia on biopsy esp with +ve FHx is a RF
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Geography & BC
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Low incidence in Far East and Eastern Europe
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Misc factors & BC
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Obesity in postmen, high SE group, high sat fats/alcohol, smoking not a RF, lactation probably protective
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Ideal MDT BC team
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Consultant breast surgeon, consultant oncologist, breast care nurse, two radiologists, histopathologist
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BC pts referred from
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Surveillance or GP
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Breast lump Ix
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Triple Assessment
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Triple Assessment involves
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1. Hx & Ex, 2. Mammography & US, 3. FNA cytology or core biopsy
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FNA procedure
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10ml syringe attached green needle, contents on slide, smeared, labelled, stained with haematoxylin & eosin assigned cytology 1-5
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FNA lump disappears DD
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Cyst
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FNA solid lump DD
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Lumpy breast tissue, fibroadenoma, BC
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C1 means
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Insufficient material to Dx (usu fat cells)
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C2 means
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Benign cells
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C3 means
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Uncertain of Dx
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C4 means
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Probably BC
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C5 means
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BC
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Mammography views
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Craniocaudal and oblique views
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BC characteristic mammogram appearance
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White asymmetric spiculated lesion containing microcalcification
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DCIS mammogram appearance
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Cluster microcalcification
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% BC missed by mammography
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7%, 12% in premen (denser breast tissue), lobular carcinoma classically missed
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USS use
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Adjunct to mammography, good at seeing cysts, requires skill and time
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Core biopsy or excision if
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FNA C1/C3 and radiology/Ex suspect BC
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Core biopsy and excision allow
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Histological Dx, discriminate invasive/in situ carcinome
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Core biopsy procedure
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Shallow LA then deeper infiltration, skin punctured with scapel, core biopsy needle pushed into lump/gun
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Core biopsy/FNA can be guided by
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USS, mammography, stereotactic integration of digital mammography (Mammomat)
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Early breast cancer defined as
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Clinical stages 1 and 2
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Advanced breast cancer defined as
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Clinical stages 3 and 4
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TNM stands for
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Tumour, nodes, metastases
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T stages
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T1 <2cm, T2 2-5cm, T3 >5cm, T4 direct extension to skin/chest wall
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N stages
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N0 no palpable LN, N1 mobile ipsilateral LN, N2 fixed ipsilateral LN, N3 supra/infraclavicular LN or arm lymphoedema
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M stages
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M0 no evidence distance mets, M1 distant mets
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% palpable axillae nodes contain mets
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25%
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% non-palpable metastatic LN
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25%
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Rx clinical stage 1/2
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Surgery
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Rx clinical stage 3-4, locally advanced, mets
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Avoid surgery, Ix e.g. core biopsy of primary, CT, bone scan, FBC
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Modalities of BC Rx
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Surgery, radiotherapy, endocrine therapy, cytotoxic chemotherapy, psychotherapy
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